The report, by the Trust for America’s Health and the Robert Wood Johnson Foundation, cautions that in the years since the terrorist attacks of Sept. 11, 2001, and, later that fall, the anthrax mailings that killed five people, the country has made strides in being ready to prevent or deal with bioterrorism and new, high-risk diseases such as particularly deadly strains of flu – but also that funding for public health nationally has fallen during the last decade.

“Millions of Americans still contract infectious diseases each year and, worldwide, they are the leading cause of death of people under the age of 60,” the report says. “Fighting infectious disease requires constant vigilance.”

The two groups rated the 50 states and the District of Columbia in 10 areas, such as how many people get shots for the flu or whooping cough, whether public health funding is steady, or whether a state’s labs can handle a surge of testing over several weeks in event of the outbreak of disease. Missouri scored a six, as did eight other states. That was the best in the Midwest other than Minnesota. Seven states scored a seven, and New Hampshire scored eight.

“I was pretty happy with Missouri,” Curry said.

While noting improvements, the report cites “persistent areas of vulnerability, including in biosurveillance, the ability to provide mass care in emergencies, maintaining a stable (medical countermeasures) strategy to continue research and development of vaccines and antiviral medications and helping communities become more resilient to cope with and recover from emergencies.”

Get that flu shot

Much of the report deals with efforts to convince people to get vaccinated. For example, in only a dozen states, not including Missouri, did more than half of the population get a flu shot last winter. One-fifth of Americans get the seasonal flu each year. A quarter million end up in the hospital – costing $16 billion in lost wages – and 3,000 to 49,000 die, the report says.

Nationally, 45 percent of Americans 6 months or older got a flu shot last year; in Missouri, the rate was 46.4 percent. But local health departments – Curry cited the Independence Health Department – do get the word out.

“I think the Health Department’s done everything they can,” he said.

The report also targets whooping cough.

“Whooping cough’s nothing to mess with,” Curry said.

The federal government wants to see 90 percent of babies 19 to 35 months old get vaccinated, but only Connecticut, Delaware and the District of Columbia meet that goal. Missouri’s incidence of whooping cough is slightly above the national average. The report says vaccinations prevent 14 million cases of whooping cough and measles a year and save $9.9 billion in direct health-care costs. Still, 2 million children under 3 have not had all of their recommended shots, and both whooping cough and the measles are on the rise in parts of the country.

Curry said this is the part of the report that most jumped out at him. Many states, including Missouri, allow parents to opt out of having their children get such vaccines.

“That’s not a good decision,” he said.

The report puts it this way: “The failure to vaccinate all preschoolers with all of the recommended immunizations on time leaves 2.1 million young children unnecessarily vulnerable to preventable illnesses.”

Whooping cough can get around quickly.

“When those kids get sick, they take it to school, and the other kids who are unvaccinated get sick, too,” Curry said.

The report also singled out another vaccine. Half of the states, including Missouri, either require the HPV vaccine or offer it along with educational efforts. Human papillomavirus causes cervical cancer, and the report says 79 million Americans carry the virus. There are 32,000 new cases of cancer annually, mostly in women, but only one-third of teenage girls nationwide have had the vaccine.

Community readiness

Curry said he might have suggested a different question for the report: Can your local health department get 90 percent of the area’s population vaccinated against a sudden outbreak within 48 hours. Local health officials, for example, hold exercises on drive-through clinics, giving away items such as flashlights instead of giving shots but still simulating a mass-vaccination event. That means the area has a higher degree of readiness.

“I think it’s in very good shape,” Curry said.

The U.S. does have a Strategic National Stockpile, stored around the country. It contains, for example, enough smallpox vaccine for everyone in the country plus medicine to ward of anthrax for millions. Some medicine from that stockpile was distributed during the H1N1 pandemic in 2009, which was considered mild but infected 60 million Americans – close to one-fifth of the country – and killed 12,000. What was notable is that, unlike the case with seasonal flu, 90 percent of the deaths were among those under age 65.

The report also looked at these areas:

• Only 17 states maintained or increased funding for public health services from fiscal year 2011-12 through 2012-13. Missouri was not among those 17. The report’s argument is straightforward: It is public-health agencies that have to monitor and quickly investigate any outbreaks of disease and then get the word out and distribute medicine.

“Currently, the United States lacks an integrated, national approach to biosurveillance – which limits the rapid detection and tracking of diseases,” the report says. “There are more than 300 different health surveillance systems or networks supported by the federal government. These efforts, for the most part, are neither integrated nor interoperable ...”

• Three-fourths or more of the states, including Missouri, require that health-care facilities report health-care-associated infections, that labs have a plan in place to handle a six- to eight-week surge of testing – 300 percent – if there’s an outbreak, and that public health labs be able to move samples to the right lab quickly.

• Half of the states, including Missouri, have and test plans to keep public health labs up and running even if the outbreak of disease keeps workers off the job. Curry prepared a similar plan for the county. “In Jackson County, we’re in pretty darned good shape,” he said.

• The Medicaid programs in Missouri and 30 other states have routine HIV testing.

• Fifteen states, not including Missouri, have plans to deal with how climate change will affect human health.